Perhaps 60,000 plus dead in the UK? In a crisis some mistakes are inevitable. Add in a healthy dose of the stupidity of the privileged and they get worse. Underpin both with structural failure and you have a recipe for disaster. This is what has happened in the UK. Governments have simply failed maintain a proper public health system.
The Dream of Public Health
The dream of public health has always been to stop illness and injury before they can start. But if public health works you do not see it. It then does not look necessary. Worse, although prevention may be better than cure it means regulations. And if you can make money out of cures then the pressure of profit pushes the emphasis to managing diseases – not stopping us getting them. So public health always gets less than it should.
How they unravelled basic structures.
The pressures on public health have become worse because successive UK governments have become hostile to well-funded public services.
- Governments cut at the centre – they eliminated the Central Office of Information (a suggestion that a unit be retained to deal with emergencies like pandemics was rejected.) They reduced support for Public Health England, they chopped back the Health and Safety Executive etc.
- Governments cut back on local council support forcing them too to cut all local services including their health role services.
- Governments disorganised by outsourcing and creating fake markets – look at the NHS. This opened up door for lucrative private contacts and advisers but it removed the ability to co-ordinate.
Outsourcing and Parallel Structures
Normal outsourcing is all about sub contracting and sub sub contracting. Sometimes the state creates government owned companies run on commercial lines like the NHS Supply Chains Solutions. It then subcontracts to others like Unipart.
But the state can also subcontract directly to private companies as it did with the NHS PPE store that was run by Movianto – a subsidiary of the US Owens & Minor International Logistics
When a crisis occurs you then find you do not have what you need so you try to create parallel structures. You get the someone like the accountants Deloitte to do it for you. You have your testing centres run by Serco, GS4 , Sodexho, Boots. They too will be using consultants and sub-contracting because they have limited expertise.
Coronavirus is threatening to pull down many businesses. You can protect your situation by becoming a government outsourcer. Some of the usual suspects doing well from a crisis
Deloitte, KPMG, Capita, Serco, Sodexho, G4S, Boots,
Palantir, Mitie, Clipper Logistics,
and, of course – Big Pharma
Why Outsourcing Fails
The whole model is a mess. These companies
- depend on cheese paring, low pay and poor training to make profits.
- lack expertise – they often have no track record, they have to buy in consultancy at huge cost and, if they lose contracts, there is no continuity
- operate in a disorganised way. There is a lack of coordination with the state. But there is also a lack of co-ordination between companies over what they do.
- are not transparent – they hide costs and performance behind commercial secrecy
No real penalties for screw ups
Often the failures seem to occur in slow motion as deficiencies are exposed over time. Outsourcing companies have been found guilty of lying and cheating and breaking the criminal law. The Big 4 accountancy companies like Deloitte and KPMG have turned a blind eye to the criminal failures of others. All they get are puny fines.
Sometimes the failures can be really spectacular. G4S messed up the Olympics and the army had to be sent in. Now the Movianto has messed up the PPE stockpile and the army has had to be used again.
Still these failing companies lead charmed lives. They walk away with slaps on the wrist and come back again later when all is forgiven. It is we who pay for this, sometimes with our lives.
The Vicious Circle Continues
Having undermined the capacity of the state to step in the UK government has now rushed into the arms of the usual suspects
But this only gives the appearance of a solution.
- In an emergency all pretence at competitive bidding is dropped. You simply go to the existing companies whatever their inadequacies or take up nepotistic offers from your mates.
- Because these are private companies doing the state’s job you intensify the transparency problem just when you need it the most
- Because they have to get stuff up and running from scratch these companies will have to learn by doing – even if they are successful huge mistakes are guaranteed along the way.
- And, of course, there will be co-operation problems and a disjointed effort. Look at testing GPs, for example, have not been getting tests results for their patients who have been commercially tested. Look at the doubts about how the contact tracing will work and connect with people on the ground.
So yes, it is a huge mess and yes it has cost and is costing lives. Will it change? That is up to us.